Recreational Injury Interventions
Handball is one of the most popular sports in Denmark, with approximately
137,000 players registered in the Danish European Team Handball Association. Up
to 50 injuries per 1,000 game hours have been reported in European handball, Wedderkopp et al, 1999.
It is a sport in which injuries are common and most frequent in the lower extremities.
Additionally, it has been reported that more than 50% of traumatic handball injuries
occur in the lower extremities, Wedderkopp et al, 1999.
Poor postural control, which can be improved through balance and propriocpeitve
training, is believed to significantly contribute to the incidence of lower extremity
injuries. Ankle disk or balance training has been reported to have a positive effect
on balance and proprioception in athletes who have had injuries to their knee or
ankle, Wedderkopp et al, 1999.
The study reviewed below evaluates the effectiveness of a balance
training and warm-up intervention program in reducing the number of traumatic injuries
to the lower extremities in young female handball players who have not necessarily
endured a previous injury.
Review of handball studies:
Study design and target population
|Randomized controlled trial.
Population: Female European handball players.
11 teams (111 players) in intervention group, 11 teams (126 players) in control
Age 16-18 years.
|Training program consisting of 10-15
min. ankle disk session at all practices and 2 or more functional activites
to warm-up all muscle groups in the upper and lower extremities for 10 months,
(Aug 1995 - Ma y 1996).
|Injury incidence for all injuries,
injury incidence for lower extremity injuries, injury severity, position specific
|Control group 5.9 times higher risk
of acquring an injury than players in the intervention group.
There were significantly more ankle and finger sprains in
the control group than the intervention group. 23 ankle (P<0.01) and 9
finger sprains (P<0.05) in control group, compared to 6 ankle (P<0.01)
ankle and 1 finger sprain (P<0.05) in the intervention group.
Significant difference with respect to injury incidence and
playing position between intervention and control groups (P<0.01). For
intervention group 6 defense, 6 offense, 1 midfield, 1 during warm-up. Compared
to 13 defense, 40 offense, 5 midfield, 8 during warm-up for the control group.
Practice time and not using the prevention program were the
only significant risk factors (P<0.05). Odds-ratio for players in prevention
program and practicing 6 hrs/week was the lowest 0.21 (95% CI 0.01-4.87) compared
to those practicing 2 hours/week 0.60 (95% CI 0.21-1.69).
Practice time was directly proportional to odds-ratio for
control group, with the highest ratio being 8.04 (95% CI 1.61-40.11) for those
who practiced 7.5 hrs/week and 2.30 (95% CI 1.21-4.34) for those praciting
Study quality and conclusions
|Intervention program appeared to decrease
the number of both traumatic and overuse injuries significantly.
Significantly lower number of injuries in
the intervention group for only minor and moderate injuries.
Incidence of injury for control group may have been effected
by increased injury awareness due to participation in the study.
Difficult to determine whether the balance training or the
warm-up was the major factor in reducing injury rates.
Summary of handball studies
It may be possible to reduce the number of and incidence of lower extremity injuries
in young female handball players through balance training and warm-up intervention.
Young athletes, in particular, are at a very high risk of sustaining
injuries, therefore there is a need for an effective intervention program.
Recommendations on handball
A prevention program that incorporates warm-up
and balance training in all practices is recommended at this time. Additionally,
injury awareness sessions may also prove to be beneficial injury prevention intervention.
Recommendations for future
Future research should consider
the effects of injury awareness and education on injury prevention, and examine
the benefits of balance training and warm-up interventions independently. Furthermore,
the impact of recurrent injuries should be considered.